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Abstract - ID: 3 1 Abstract - ID: 3 Authors: Lindsey Grove, Elon University; Scott Rezac, Rezac and Associates Physical Therapy, LLC Title: Manual cervical spinal mobilization improves extremity strength and paresthesia in a patient with multi-quadrant symptoms secondary to cervical myelopathy Background / Purpose: Cervical spine myelopathy (CSM) is a clinical diagnosis involving the cervical spine, spinal cord, spinal nerve roots, and other surrounding tissues that can result in various debilitating physical symptoms. Literature comparing surgical, conservative, and physical therapy outcomes is lacking. The purpose of this case report is to demonstrate how physical therapy consisting of manual therapy, neural re-education, therapeutic exercise, and functional training was used to successfully treat an individual with stable CSM. Case Description: The patient was a 69-year-old Caucasian female, ¾ pack a day smoker self-referred to outpatient physical therapy for progression of paresthesias in all extremities with insidious onset 9 months prior. She had previously received a medical diagnosis of peripheral neuropathy and undergone an inconclusive EMG study. No cervical pain was reported at evaluation; however, limited cervical range of motion, palpable tenderness to C4-C7 paraspinals, mild right foot drop, gait deviation, quadriceps hyperreflexia, and a positive cervical distraction test was seen. The physical therapist made a differential diagnosis of CSM based on the presence of these clustered clinical findings and past medical history. Evaluation results were communicated to the physician who signed off on the physical therapy plan of care for stable CSM. The course of treatment consisted of 26 sessions that took place over 5 months. Outcomes: Reduction of lower extremity paresthesia was seen as early as the first session. A significant improvement of 67/80 (25% impairment) to 73/80 (7.5% impairment) in the subjects Lower Extremity Functional Scale score was observed. Right lower extremity manual muscle testing for dorsiflexor strength improved from 3/5 to 5/5. Improvements in cervical ranges of motion were noted. At discharge she was able to ambulate and perform gardening tasks for greater than 60 minutes without symptoms compared to at evaluation in which she experienced symptom onset in less than 15 minutes. Sleep quality improved from 50% to 0% disturbed at discharge. Subject reported overall return to full function. Discussion / Conclusion: Manual therapy consisting of manual cervical traction, lateral side glides at C3-C7, upper thoracic spine manipulation, and individualized extremity neural flossing techniques. Carry over for spinal segmental mobility and dynamic motor control was promoted with progressive therapeutic exercise and functional training such as deep neck flexor training coupled with lifting and bending tasks. Manual therapy interventions were utilized as indicated and tapered throughout treatment. This case report demonstrates physical therapy management of symptoms associated with CSM and may offer treatment options for future patients with stable CSM. Further research should be conducted to provide objective data to support the findings of this case report. 2 Abstract - ID: 5 Authors: Ronald Schenk, Daemen College Title: Mechanical diagnosis and therapy instruction in accredited physical therapy programs in the United States Background / Purpose: Over 10% of all medical visits are directed toward musculoskeletal pathology or impairments in the United States, and a number of these affected individuals are referred to physical therapy. Physical therapy interventions for musculoskeletal disorders may include physical agents, stabilization exercises, manual physical therapy, and an exercise prescription which is based on the testing of repeated end range movements, which is foundational to the Mechanical Diagnosis and Therapy (MDT) approach. Often referred to as the McKenzie Method, MDT is a musculoskeletal classification based system developed by Robin McKenzie, a New Zealand physiotherapist, and the approach has been shown to be efficacious in the management of spinal musculoskeletal disorders. Despite the fact that research regarding the effectiveness of MDT is emerging, there is currently no evidence as the extent of MDT education in professional and post-professional physical therapy programs. Therefore, the purpose of this study was to determine the extent to which MDT is instructed at the professional and post-professional level. The results from this study may be of value as an assessment tool for existing curricula within the framework of a program’s educational philosophy and curricular plan. Additionally, the results may also be helpful for the development and facilitation of MDT instruction in entry-level physical therapy education programs, orthopaedic residency programs, and OMPT programs that do not currently address this content. Methods: This cross sectional study explored the extent of MDT instruction in physical therapy professional degree programs accredited by CAPTE and the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE). Three-hundred and fifty invitations to complete the survey were sent via email to program directors of physical therapy professional degree programs accredited by CAPTE and ABPTRFE. A letter of instruction was provided to each subject outlining the purpose of the study, an explanation of the anonymous nature of the survey, and that participation was voluntary. The survey included a request to forward the email to the McKenzie Institute for teaching MDT content. They were also provided with a link to complete the survey through a web-based service (Survey- Monkey.com). Summary of Findings: A total of 96 programs responded to the survey (response rate = 27.4%). Of these programs, 84 (87.5%) had integrated the McKenzie principles into their curriculum. Of the 84 respondents, 23 indicated that McKenzie principles were integrated into a required, entry-level or post-professional course, 40 indicated that it was part of the required integrated practice expectation content, and 16 did not report having an entry-level program. Faculty teaching MDT content appear to be well qualified, with the majority having more than 13 years of experience using McKenzie treatments in clinical practice. The primary reason for programs not teaching McKenzie principles is that it was not considered to be of high enough curricular priority for inclusion (n=4). Of the 96 programs that responded to the survey, eighty-four (87.5%) had integrated the McKenzie principles and practice into their entry-level education programs (Figure 1). The programs currently not teaching MDT reported several reasons, including lack of qualified faculty (n=4, 41.7), lack of scientific evidence to guide what is to be taught (n=1, 10.4), and the remainder provided individual responses within the other category, including eliminating the content to better follow low back pain clinical practice (n=1, 10.4%) and teaching concepts of McKenzie but not the entirety of the method (n=4, 41.7). Also in a separate question, all of the programs that had not integrated MDT do not plan to incorporate it into their curriculum in the future (n=12, 100%). 3 Of the 96 programs that responded to the survey, eighty-four (87.5%) had integrated the McKenzie principles and practice into their entry-level education programs (Figure 1). The programs currently not teaching MDT reported several reasons, including lack of qualified faculty (n=4, 41.7), lack of scientific evidence to guide what is to be taught (n=1, 10.4), and the remainder provided individual responses within the other category, including eliminating the content to better follow low back pain clinical practice (n=1, 10.4%) and teaching concepts of McKenzie but not the entirety of the method (n=4, 41.7). Also in a separate question, all of the programs that had not integrated MDT do not plan to incorporate it into their curriculum in the future (n=12, 100%). Discussion / Conclusion: This study examined the status of MDT education in entry-level education programs for physical therapists. To our knowledge, the results provide the first description of MDT education in entry-level education programs for physical therapists in professional and post-professional therapy programs. While most of responding programs (87.5%) stated that the McKenzie principles were currently included in their curricula, the results of our study demonstrate some variability in the educational background of the clinicians teaching and the years of experience the clinician had using MDT in clinical practice. For example, 36.23% (n=25) have completed part D of MDT training and 13.04% (n=9) of clinicians teaching MDT are diplomaed. This educational background can lead many clinicians to believe they are knowledgeable on MDT; however, only implementing extension based concepts to their patients. Of the clinicians that are instructing MDT, only 47.83% had greater than 13 years’ experience implementing MDT in clinical practice. These inconsistencies may be related to a current lack of guidelines, regulations, and standards for MDT content within educational requirements, which may be a reflection of the current variable role of the McKenzie principles in physical therapist practice. Of the 96 programs that responded to the survey, 84 programs had integrated the McKenzie principles and practice into their entry-level education programs. There appeared to be variability in how the McKenzie
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